Volume 89  ·   Issue 07  ·  2009

Objective To investigate the curative effect of managing infected nonunion with large skeletal defects utilizing debridement and granulated cancellous bone grafting. Methods Nineteen patients (20 sites)of infected nonunion with large skeletal defects in tibiae (n = 18) or ulna/radii (n =2) , 18 males and 1 female aged 31.3 (8-51), were treated with debridement,external fixation, and granulated cancellous bone grafting,14 patients (15 sites) by cancellous bone autografting and 5 patients (5 sites) by cancellous bone allografting. Follow-up was conducted for 32. 7 (20 - 56) months. Results Out of the 5 patients receiving allogra-fting, 3 gained bone union with an external fixator index of ( 2. 22 ± 0. 84 ) months/cm, 2 developed nonunion and subsequently gained union after receiving cancellous bone autografting, and no infection recurrence all of the 5 patients were found. Out of the 14 patients (15 sites) undergoing autografting, 2 patients (2 sites, 13. 3% )developed nonunion due to recurrent infection resulting in absorption of autograft, subsequently received debridement and autograftiug once again, and gained bone union and infection eradication; 12 patients ( 13 sites, 86.7% ) gained bone union with an external fixator index: of (1.96 ± 0. 74) months/cm. Re-fracture occurred in 3 patients (4 sites) and was cured by using cast immobilization (1 case), external fixator (1 case), or internal fixation (1 case). Conclusion Granulated cancellous bone autografting is a suitable method for managing infected nonunion with large skeletal defects. And cancellous bone allografting has a higher incidence of re-nonunion and longer time for using external fixator.

Objective To investigate the relationship between neuroendocrine differentiation (NED) in prostate cancer and hormone refractory prostate cancer. Methods Fifty-five prostate cancer specimens were obtained from 55 patients following intermittent androgen blockade during operation of transurethral resection of prostate. Monoclonal antibody immunohistochemistry was used to detect the expression of chromogranin A ( CgA ), a specific marker of neuroendocrine cell in the specimens. Follow-up was conducted for 25 (5-85) months. Serum prostate specific antigen (PSA), bone scan, chest X-ray, and computerized tomography were performed regularly during follow-up. Results Twenty-six of the 55 specimens (47.3%) were positive in CaG, and 23 of the 35 tumors with the Gleason score ≥7 was 66%, significantly higher than those of the lower-grade tumors (all P < 0. 01).Most of the high-grade tumors showed small cluster pattern, and most of the low-grade tumors showed solitary scattered pattern. The numbers of NED cells in the stage Ⅲ and Ⅳ tumors were 67% and 71.4% respectively, both significantly higher than that of the stage Ⅱ tumors (25%, both P <0.05), There was no correlation between the NE positive cell rate and preoperative PSA value ( P > 0. 05 ). Thirty cases progressed to a hormone-independent status within 18 (5 -79) months (Group A), and the rest 25 cases remained not progressing within 31 (17 - 85) months (Group B). The NED rate of Group A was significantly higher than that of Group B (P <0. 05). Univariate analysis showed that NE positivity, Gleason≥ 7, stage Ⅳ, and bone metastasis were influential factors of clinical progression. Multivariate COX regression analysis showed that NED and pre-operational PSA value were independent prognostic factors of bone metastasis. Conclusion NED is associated with poor prognosis and hormone refractory prostate cancer in patients with androgen deprivation therapy.

Objective To investigate the change of serum levels of the pro-inflammatory cytokines: macrophage migration inhibition factor (MIF), tumor necrosis factor-a( TNF-α), and interleukin 6 (IL-6), in patients with diabetic peripheral neuropathic pain (DPNP) and their role in the pathogenesis of related diseases. Methods Peripheral blood samples were collected from 28 patients with diabetes mellitus (DM) without complications , and gender ratio- and age-matched 32 patients with diabetic peripheral neuropathy ( DPN), 28 patients with DPNP, and 28 normal controls. Dual-antibody ELISA was used to detect the serum MIF, TNF-α, and IL -6 levels. Results The serum MIF, TNF-α, and IL-6 levels of the DM, DPN, and DPNP groups were all significantly higher than those of the control group (P < 0. 001, P < 0. 05). The serum MIF and TNF-α levels of the DPN and DPNP groups were all significantly higher than those of the DM group (P <0. 05 or P < 0. 001 ), while there were not significant differences in the serum MIF and TNF-α levels between the DPN and DPNP groups ( both P > 0. 05 ). There was not significant difference in the serum IL-6 level among the DM, DPN, and DPNP groups as well (all P > 0. 05). The correlation analysis show that the levels of MIF , TNF-α and IL-6 each other were positively correlated (r =0. 337, P <0. 01 ; r=0.216, P<0.001;r=0. 281,P<0. 05). Conclusions The serum pro-inflammatory cytokines MIF, TNF-α, and IL-6 levels play an important role in the pathogenesis of DM and DPN, but may not play an important role in the development of DPNP.

Objective To explore the mRNA expression of MyoD gene in the skeletal muscles of myotonic dystrophy (MD) patients. Methods Muscle biopsy specimens were obtained from the biceps muscles of arm of 4 MD patients and 4 healthy controls. Semi-quantitative reverse transcription polymerase chain reaction was performed to evaluate the mRNA expression of MyoD in the specimens. Results The mRNA expression index of MyoD of the MD patients was (0. 267±0. 114), significantly lower than that of the healthy controls [(0. 788 ± 0. 136), P = 0. 001]. Conclusion Down-regulated mRNA expression of MyoD gene is involved in the mechanism of DM.

Objective To investigate the clinicopathological characteristics and differential diagnosis of primary peritoneal adenocarcinoma. Methods The clinico-pathological data of 8 patients with primary peritoneal adenocarcinoma, all ferrule, aged 55. 7 (45 -69), were analyzed retrospectively, Immunohistochemistry was used to detect the expression of pan-cytokine, cytokine (CK)7, CK20, CA125, CEA, epithelial membrane antigen (EMA), vimentin, calretinin, and P63 in the specimens of tumor obtained during tumor reduction surgery. Microscopy was conducted for pathological examination. Results The common clinical symptoms of these 8 patients included abdominal distention and aseites. Pre-operationally, 6 cases were diagnosed as with ovarian cancer,Ⅰcase as with malignant mesothelioma, andⅠas with peritoneal carcinoma. The misdiagnosis rate was 87.5%. Post-operational pathological examination showed 7 cases of serous papillary adenocarcinoma and one case of mutinous adenocareinoma. Immunohistochemistry showed the positive rates of the different biological markers as follows : pan-CK (8/8) , CK7 (8/8) , CK20 (1/8), CA125 (7/8), CEA (7/8) , EMA (8/8) , vimentin (1/8), calretinin (1/8), and P53 (8/8). Conclusion A rare malignant tumor arising from the secondary Müllerian system, primary peritoneal adenocarcinoma shares similar histopathological characters with ovary carcinoma,so is easy to be misdiagnosed. Immunohistochemical staining is helpful to the differential diagnosis.

Objective To explore the safety and efficacy of intravenous iron sucrose in maintenance dialysis and to establish the optimal administration frequency and dose. Methods One hundred and ninety-four patients on maintenance dialysis with the hemoglobin (Hb) level of 60 -100 g/L and hematocrit(Hct) of 18% -30% were randomly divided into 2 sex, age, duration of dialysis, weekly erythropoietin dosage, and hematological parameters-matched groups: intravenous iron sucrose group (n = 102) and oral medication group ( n = 92 ). The intravenous iron sucrose group were sub-divided into 2 subgroups : ① hemodialysis (HD) subgroup receiving intravenous iron sucrose 200 mg once a week for 4 weeks and then 100 mg once a week for a further 8 weeks, and ② peritoneal dialysis (PD) subgroup receiving intravenous iron sucrose 200 mg once a week for 4 weeks and then 200 mg once every other week for a further 8 weeks. The oral medication group received ferrous succinate 200 mg tid for 12 weeks. The levels of serum ferritin (SF), transferrin saturation (TSAT), Hb, and Hct were examined before treatment and 4, 8, and 12 weeks after treatment. Results(1) Compared with baseline levels, the levels of Hb, Hct, SF, and TSAT significantly increased 2 weeks after treatment in the intravenous iron sucrose group, and 4 weeks after treatment in the oral medication group ( all P < 0. 05 ). (2) The Hb, Hct, SF, and TSAT levels 4, 6, 8, and 12 weeks after treatment of the 2 intravenous iron sucrose subgroups were all significantly higher than those of the oral medication group (all P <0. 05). (3) The Hb, Hct, SF, and TSAT levels 12 weeks after treatment 6, 8, and 12 weeks after treatment were not significantly different from those d weeks after treatment in the intravenous iron sucrose group ( all P >0. 05 ). (4) The response rate of the intravenous iron sucrose group was 95.09%, significantly higher than that of the oral medication group (55.44%, P < 0. 05). (5) The mean EPO doses 6, 8 and 12 weeks after treatment of the intravenous iron sucrose group were significantly lower than that before treatment and those of the oral medication group (all P < 0. 05). (6) The Hb, Hct, SF, and TSAT levels maintained stable during the period 6, 8, and 12 weeks after treatment in the intravenous iron sucrose group despite the decrease in dose and frequency.(7) The Hb, Hct, SF, and TSAT levels were significantly higher in the intravenous PD subgroup than in the intravenous HD subgroup. (8) No adverse event was found in the intravenous iron sucrose group, and adverse gastrointestinal effects occurred in 12 patients of the oral medication group. (9) After 12 weeks, the cost of EPO + intravenous iron sucrose was significantly higher than that of EPO + ferrous succinate. Conclusion Intravenous iron sucrose effectively increases the serum iron parameters and hemoglobin levels during maintenance peritoneal dialysis and is well tolerated. Infusing intravenous iron sucrose 200 mg every two weeks can maintain the serum iron parameters and hemoglobin level in maintenance peritoneal dialysis patients and n permits reduction of the required dose of EPO. However, the total cost of intravenous iron treatment is relatively high.

Objective To study the relationship of long-term effect of trabeculotomy on primary congenital glaucoma and the related risk factors. Method 164 consecutive patients with primary congenital glaucoma (257 eyes), underwent initial surgery of trabeculotomy between 1996 and 2007. Follow-up was conducted for 30.9 (8.6-58. 3) months, with a follow-up rate of 89.02%. Multivariate analysis by Logistic regression was conducted to analyze the relation of the factors including age of onset, time between onset and operation, preoperative intraocular pressure, clarity of cornea, and comeal diameter to the failure of surgery. Cox proportional hazards regression modeling was used to analyze the factors related to success of surgery. Result Multivariate logistic regression showed that the preoperative intraocular pressure (IOP) and clarity of cornea were independent risk factors for final outcome ( ORIOP = 1. 408, P = 0.047, and ORCLA =1. 691, P =0. 019). Cox regression showed that clarity of cornea was the factor related to the surgery success time ( ORCLA = 1. 632, P = 0. 008 ) . Conclusion Clarity of cornea reflexes the condition of primary congenital glaucoma more stably than IOP. It is possible to prognosticate the surgical outcome to combine the clarity of cornea with the lOP value before operation.

Objective To investigate the optimal dose of local anesthetic mixture in ultrasound-guided infractavicular brachial plexus block via coracoid approach. Methods 160 patients scheduled for surgery of the hand or forearm were randomly divided into 4 equal groups ( Groups A, B, C, and D). To receive 8,7,6, or 5 ml of anesthetic mixture of 0.75% ropivacaine and 2% lidocaine for radial nerve, axillary nerve, median nerve, ulnar nerve, median cutaneous nerve of arm, median antebrachial cutaneous nerve, and lateral antebrachial cutaneous nerve respectively ultrasound-guided infraclavicular brachial plexus block via coracoid approach. The time for anesthesia taking effect ,anesthesia maintenance time, and quality of sensory block were observed. Results Anesthesia took effect about 4 minutes after injection in these 4 groups without significant differences among then( all P > 0. 05 ). The good analgesic effect rates of Groups A, B, and C were all 100%, all significantly higher than that of Group D ( 87. 5 %, P = 0. 027 ). The block maintenance times of Groups A, B, and C were (377 ± I 11 ) min, (369 ± 135) min, and (351 ± 112) min respectively , all significantly longer than that of Group D [ (296 ± 101 ) min,P =0. 024]. No anesthesia-related complication was found in these 4 groups. Conclusion Ultrasound-guided infraclavicular brachial plexus block via coracoid approach can reduce the volume of local anesthetic mixture. The dose of 6 ml local anesthetic mixture for each nerve fascicle, totally 18 ml, provides good analgesic effect and does not seem to affect the time for anesthesia taking effect.

Objective To investigate the influence of different degrees of neuromuscular blockade on motor evoked potential (MEP) of forearm muscles under the same condition of anesthesia depth and analgesia. Methods Forty ASA Ⅰ - Ⅱ patients aged 20-60 underwent general anesthesia via intravenous injection of propofol, fentanyl, and vecuronium to achieve the bispectral index (BIS) at the level of (50 +10) during neurosurgical operation. The patients were all given fentanyl infusion at a rate of 2 μg/kg/h during the operation and continuous vecuronium injection while the value of train of four stimulations (TOF) was monitored under 3 different levels: TOF=4 ( TOF4 ), TOF = 2 ( TOF2 ), and TOF = 0 ( TOF0 ). The values of amplitude and latency at the 3 forearm muscles, forearm flexors ( FF), abductor pollicis brevis (APB), and abductor digiti minimi (ADM) were monitored and compared under stable hemodynamic status. Results There was no significant differences in the latency of compound muscle action potential (CMAP) between the anesthesia status TOF4 and anesthesia status TOF2 in FF, APB, and ADM ( all P > 0. 05). The amplitude of CMAP deceased gradually as the degree of neuromuscular blockade increased in FF,APB, and ADM (all P < 0.05).CMAP could not be recorded when the value of TOF was 0 (P < 0. 01 ). Conclusion Neuromuscular blocking drugs significantly depress the MEP in a dose-dependent manner, lntra-operatively it may be preferable to maintain the value of TOF not less than 2 during the critical periods of MEP monitoring.

Objective To investigate the impact of doparminergic therapy on the onset of motor complications in Parkinson's disease (PD). Methods Two clinical questions were identified. (1) Whether levodopa (LD)dose, LD treatment duration, the time from disease onset to initiation of LD can predict the onset of motor complications in PD? And (2) whether dopamine agonists (DA) used in de novo patients can delay the onset of motor complications? Literatures on observation studies of factors associated with motor complications and randomized controlled trials (RCTs) of DA compared to LD in treatment of de novo patients published before May 2008 were retrieved from Pubmed,Embase,and Cochrane Database. Methodology quality was critically assessed. Results 12 articles on the first question were selected,including one RCT, five cohort studies, six case-control studies. Six RCTs on the second question were selected. Because of clinical heterogeneity among the researches thus retrieved, meta-analysis was not conducted, and qualitative analysis showed that initial LD dose, LD dose per kilogram body weight, accumulated LD dose, and accumulated LD equivalent dose might be independent factors associated with motor complications.The time from disease onset to initiation of LD was not correlated with motor complications. DA as initial treatment was associated with later occurrence of dyskinesias (CALM-PD:HR =0.37, 95% CI: 0.25-0.56, P < 0.001 ; PELMOPET: HR = 0.48,95% CI=0.29-0.80, P<0.001 ; Ropinirole 056 : HR = 0. 4,95 % CI: 0.2-0.8, P=0.007 ; REAL-PET: HR=8.28,95 % CI: 2.46-27.93, P < 0.001) . The relationship between LD treatment duration and motor complications could not be concluded from present evidence. Conclusion Initial LD dose, LD dose per kilogram body weight, accumulated LD dose, and accumulated LD equivalent dose may be independent factors associated with motor complications. The time from disease onset to initiation of LD was not correlated with motor complications.

Objective To evaluate the effects of mesenchymal stem cell (MSC) transplantation on the growth of liver cancer. Methods MSCs were isolated from the bone marrows of SD rats. Walker-256 cancer cells were isolated from the cancerous ascites of rat and cultured. Forty-five SD rats were randomly divided into 3 equal groups: mixed transplantation group undergoing laparotomy and transplantation of cancer cells mixed with MSCs into the liver, MSC Ⅳ transplantation group undergoing injection of MSCs into the caudal vein, and control group undergoing only MSC transplantation into the liver.MR imaging was performed s at days 3, 6, 9 and 12 after modeling to measure the maximum cross section area of the tumor. At day 12 the rats were killed after MR imaging with their livers taken out to undergo HE staining and pathological examination. Immunohisochenmisry was used to detect the expression of vascular endothelial cell growth factors (VEGF), nm23 gene, a tumor metastasis inhibiting gene, and proliferating cell nuclear antigen (PCNA), a nuclear polypeptide necessary in the DNA synthesis. Results No significant evidence of tumor formation was detected by MRI at days 3 and 6 after modeling in all rats and tumor nodules were observed since day 9. The maximum cross section areas of tumor of the mixed transplantation group and MSC Ⅳ transplantation group were significantly larger than that of the control group at days 9 and 12 ( F =4.21, P < 0. 05 ; F = 8. 52, P < 0. 01). Immunohistochemistry showed that VEGF expression levels of the two study groups were both significantly higher than that of the control group ( F = 9. 58,P < 0. 01 ), while the nm23 gene expression levels of the 2 study groups were both significantly lower than that of the control group (F =4.61 ,P <0.05 ). The FCNA expression level of the mixed transplantation group was significantly higher than that of the control group (d'(1,0.05) = 0.34, d'(1,0.01) = 0. 63, P < 0. 05 ), however, there was no significant difference in the PCNA expression level between the MSCs Ⅳ transplantation group and the control group (d'(1,0.05) =0. 32,d'(1,0.01) =0.48,P >0. 05). There was no significant difference in the tumor apoptotic index between the 2 study groups and the control group (F = 1.25, P > 0. 05 ). Conclusion MSC transplantation increases the expression of VEGF and PCNA, while decreases the expression of nm23 gene in cancer cells, thus favoring the tumor growth.

Objective To investigate the effect of pigment epithelium derived factor (PEDF) on the growth of lung cancer cells and the cancer-related neovascularization. Methods The full length of human PEDF gene was amplified by polymerase chain reaction (PCR).Human lung cancer cells of the line SKEMS1 were cultured and transfected with PEDFexp, An eukaryotic expression vector constructed by recombinant DNA technology, so as to construct the SKMES1PEDFexp cells over-expressing PEDF protein. RT-PCR and Western blotting were used to confirm the mRNA and protein expression of PEDF in these cells. Another SKMES1 lung cancer cells were transfected with blank plasmids (SKMES1pEF/His cells).The SKMES1 cells not transfected were called SKMES1WT cells. The 3 kinds of SKMES1 cells were insulated in the chorio-allntoic membrane (CAM) of chick embryo hatched for 7 days respectively. The size and weigh of the tumor were measured.The vessels density was examined. Results The tumor volume of the SKMES1PEDFeap group was (0. 10 ±0. 05) cm3, significantly smaller than that of the control group [ (0. 17 ±0.07) cm3 ,P= 0. 016 ], and the mass of the SKMESPEDFexp group was (0. 008 ± 0. 004) rag, significantly smaller than that of the control group too [ (0. 024±0. 009) mg,P =0. 006]. The amount of first class neo-vessels of the SKMES1 PEDFexp group was ( 15±3 ), significantly fewer than that of the control group [(41± 9) ,P <0. 001 ]. The amount of second class neo-vessels of the SKMES1PEDFexp group was (75 ± 22), alsosignificantly fewer than that of the control group [ (175 ± 39), P = 0. 001 ]. Conclusion Inhibiting the growth of lung cancer cells and neovascularization, PEDF protein may be used as a potential biological drug to treat lung cancer.

Objective To construct an anti-sense cDNA library of human breast cancer cells to screen essential genes with anti-tumor effects on apoptosis of human breast cancer cells induced by triehostatin A. Methods Poly (A)+ RNA was extracted from human breast cancer cells of the line MCF-7 treated by trichostatin A for 0, 12, 24, 36, 48, 60, or 72 h. cDNA were synthesized and inserted reversely into PCEP 4 vector to construct an anti-sense cDNA library. HeLa cells were tansfected with the library DNA or blank PCEP 4 vector as control group. All the transfected cells were screened by 200 nmol/L trichostatin A and 200 μg/ml hygromycin B. Screening was stopped when the control cells died. Then the surviving cell clones were amplified and Hirt DNA was extracted. Several expressed sequence tags were thus obtained. The data were analyzed by bioinformaties and interested EST fragment was chosen for preliminary functional screening. Results An anti-sense cDNA library was constructed containing 2 × 106 independent clones with an insert efficiency of more than 90% ;DNA sequencing and bioinformatic analysis suggested that the No. 27 survival clone was zinc transporter LIV1 showing a strong resistance against trichostatin A-induced apoptosis during functional screening. Conclusion An anti-sense cDNA library with high quantity and quality has been successfully constructed; LIV1 gene may be one of the essential genes with anti-tumor effects on apoptosis induced by trichostatin A.

The patient was a 73-year-old male who was admitted to the hospital with the complaint of "painless jaundice for 2 weeks". The medical history was asked: the patient had intermittent postprandial right upper abdominal discomfort 2 months ago, no episodic abdominal pain, no radiating pain in the right shoulder and back, and the abdominal discomfort could be relieved by itself. In the past 2 months, he felt that his body was gradually thinning, he could eat and eat, and his defecation was still normal. In the past 2 weeks, the skin and sclera were gradually yellowed, and the stool was clay-colored. Physical examination at the hospital: the skin and sclera of the whole body were obviously yellowed, and the vital signs were stable. There were no special abnormalities in the heart and lungs, and there was no obvious tenderness in the abdomen. The liver and spleen were not palpable under the costs, no mass was palpable, and Murphy's sign (Mophy) was negative. The white blood cell count was 10.9×109/L, and the neutrophils were 0.797. The liver function was abnormal.

All the oral nucleoside drugs on the market can be resistant in the treatment of hepatitis B [1], especially the recent report that patients treated with combined nucleoside drugs have multiple drug resistance, which has attracted great attention of clinicians [2-3]. The research on hepatitis B virus (HBV) resistance, such as clinical drug resistance and HBV genome sequence analysis, has been carried out for more than ten years, and many important achievements have been made. However, more and more complex virus mutation problems require more effective research methods to analyze it. In recent years, some phenotypic resistance analysis techniques have been successfully applied to HBV cross-resistance research and anti-HBV therapy monitoring. In this paper, two in vitro experimental models of HBV phenotypic resistance, based on polymerase metabolism and based on cultured cell lines, will be reviewed.

From January 2003 to June 2006, three cases of symptomatic Rathke fissure cyst (RCC) completely located on the suprasellar were treated by neurosurgery in Guangzhou Nanfang Hospital and confirmed by pathology.

On 24 January 2009,<The Lancet Magazine's Best Paper of the Year was announced, led by Academician Zhong Nanshan and collaborated with 23 hospitals in China<The effect of carboxysteine on the acute onset of chronic obstructive pulmonary disease (PEACE study): a randomized placebo-controlled study>won the "2008 Outstanding Paper" with the highest number of votes. This is the first time that Chinese scientific and technological workers have won this honor.

angiopoietin-like protein family 4 (Angptl 4) is a member of vascular endothelial growth factor family. It is mainly expressed in fat and liver, but also in heart, kidney and other tissues. It can regulate lipid metabolism by inhibiting lipoprotein lipase activity. Adachi and colleagues of Kumamoto University in Japan studied the effects of deletion of Angptl 4 gene on lipid metabolism and atherosclerosis by ApoE (- / -) Angptl 4 (- / -) mice<Biochem BiophysRes Commun, 2008, 15.

A 4-year-old male was admitted to the hospital after 2 years of cardiac murmur. Chest X-ray showed pulmonary artery segment protrusion; Cardiac B-ultrasound showed that the inner diameter of the main pulmonary artery and the left pulmonary artery was widened (2.9 cm and 2.6 cm, respectively), the pulmonary valve was limited to open, and the pulmonary artery transvalvular pressure difference was 121 mm Hg (1 mm Hg =0.133 kPa). Pulmonary stenosis was diagnosed. Percutaneous balloon pulmonary valvuloplasty was performed under local anesthesia. The right ventricular systolic pressure was measured at 153 mm Hg, and the pulmonary artery transvalvular pressure difference was 125/mm Hg. The pulmonary artery transvalvular pressure difference was reduced to 28 mm Hg with a balloon catheter with a diameter of 18 mm and a length of 30 mm (Mansfield Company, USA).